| NPI | 1407976236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI 15971) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME160170) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2007002736) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD430465) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2025-02-11 |